Afebrile hospitalized neonates with fever history: is early discharge possible?

  • Ramgopal S & al.
  • Pediatrics
  • 25 Jul 2019

  • International Clinical Digest
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Takeaway

  • Neonates who remain afebrile during hospitalization despite a history of fever have reduced risk for serious bacterial infection.
  • These infants can possibly be safely discharged early after observation.
  • Being afebrile was not associated with risk change for invasive bacterial infection. 

Why this matters

  • These infants have historically been assumed to have infection risk that is the same as that for infants who present with fever.
  • When they have a history of fever but are afebrile at presentation, appropriate management has been a conundrum.

Key results

  • Vs a febrile presentation, ORs and 95% CIs for serious bacterial infection:
    • Afebrile, with no fever during hospitalization: 0.42 (0.23-0.79).
    • Afebrile, subsequent fever during hospitalization: 1.93 (1.07-3.50).
  • No significant differences between febrile presentation vs afebrile/no subsequent fever in odds for diagnosis of an invasive bacterial infection: 0.52 (95% CI, 0.19-1.51).
  • Infants who had been given antipyretics and were afebrile at presentation tended to develop fever during hospitalization (7/12 infants; 58.3%).

Study design

  • Single-center, retrospective study, 931 infants; mean age, 18.1 (standard deviation, 7.3) days.
  • 60.2% presented with fever; the rest were afebrile.
  • Funding: No external funding.

Limitations

  • The usual limitations of a retrospective design apply.
  • Some clinicians may have foregone testing for infection in afebrile infants.